Liposuction Procedure

When you ask what comes to mind when considering the term “liposuction”, many people automatically think “weight loss”. Unfortunately this is not the case! Liposuction is a technique for improving contour and adding definition. It may be used to target focal areas of persistent fatty tissue that linger no matter how many crunches are performed. Liposuction is one of the most common plastic surgery procedures. Ideal candidates are close to their ideal body weight with focal areas of adiposity that are unresponsive to diet and exercise. The procedure is performed for body contouring, not weight loss, and skin elasticity is important for skin retraction and tightening after surgery.

Common areas for liposuction include the abdomen, hips, buttocks, thighs, knees, neck (submental), and face (cheeks, jawline). Liposuction is performed in the operating room. Depending on the body region and anticipated duration of surgery, it is performed either under general anesthetic, most commonly, or conscious sedation for limited regions.

Post-operative compression garments are recommended to decrease swelling and aid in skin retraction. Liposuction is performed as out-patient surgery – unless combined with another surgery, such as tummy tuck – and patients are generally able to return to work within one week. It is necessary however, to refrain from strenuous activity or heavy lifting for one month.

1. What are common concerns of patients considering liposuction?

Patients considering liposuction commonly express concern regarding localized regions of fatty tissue that are unresponsive to diet and exercise. They seek contour improvement of challenging body regions as opposed to reduction of overall body weight. Liposuction may be a useful tool to address focal areas of excess fullness. It is not an effective technique for weight loss.

2. Who is a suitable candidate for liposuction?

A suitable candidate for liposuction expresses concern regarding localized fat deposits that are unresponsive to lifestyle modifications. It is important for patients to have reasonable goals when seeking liposuction and understand limitations of the surgery. Liposuction will not result in significant weight reduction. It may achieve sculpting and increased definition by removing localized fat deposits.

Body weight is one of the most important considerations when determining whether a patient may benefit from liposuction. If over 10% of one’s ideal body weight, liposuction may be less successful in body contouring. Based on clinical examination, Dr. Power may recommend a regimen to achieve weight reduction through diet and exercise before surgery in order to optimize aesthetic outcome.

In addition to localized fatty deposits, it is critical to have normal skin elasticity if considering liposuction. Once excess fat is suctioned, contour improvement depends on the ability of the skin to contract and tighten following fat removal. If performed on a patient with decreased skin elasticity, the aesthetic outcome may worsen since redundant skin will be more apparent following liposuction. For these cases, different surgical techniques may be more effective depending on the body region (for example, tummy tuck or neck lift surgery).

3. What are different types of liposuction?

Liposuction may be categorized based on adjunct technology that is employed, including suction, ultrasound, power source, or laser. The most common technique for liposuction includes an external source of suction. Ultrasound assisted liposuction has also been developed, which may be effective in removing fat within fibrous body areas or if previous liposuction or other surgery has been performed at the site. Although it may liquefy fat before suctioning, ultrasound assisted liposuction carries risk of thermal injury to skin. Power assisted liposuction is driven by a small motor and is an effective technique, particularly when treating large body regions. Despite many different types of liposuction, there is no proven benefit of one technique over the others.

4. What to expect on the day of liposuction?

It is important to begin fasting at midnight prior to surgery. Your appointment details will be provided in advance regarding the date and location to present for surgery at 199 Avenue Road.
You will be admitted and given a locker for your personal belongings.

You will meet the anesthesiologist who will be administering either your general anesthetic or conscious sedation if a smaller body region is being treated with liposuction. Dr. Power will see you pre-operatively to answer any remaining questions and to review the surgery and post-operative instructions. She will also perform surgical markings in the pre-operative waiting area before your surgery. Your blood pressure and other vital signs will be checked and then you will be taken to the operating room.

A surgical checklist will be performed in accordance with Health Quality Ontario standards to confirm patient and surgery details. You will then be placed under general anesthetic or conscious sedation, depending on the extent of planned surgery and your discussion with Dr. Power pre-operatively.

5. What to expect after liposuction?

You will wake up in the post-operative recovery area and will be wearing a compression garment. This applies gentle pressure to the surgical site and reduces the risk of bleeding, swelling, and fluid accumulation. Gauze dressings will be applied under the compression garment, which will collect any drainage from the surgical site.

Fluid is injected prior to liposuction, which serves to partially break down fat cells before suctioning and to reduce risk of bleeding and bruising. This wetting solution will continue to drain over the first few days following liposuction.

Instructions will be given regarding dressing changes. You will be able to resume showering starting the day after surgery. Prescription pain medication may be required for the first few days following liposuction and patients are then able to transition to Tylenol plain or extra-strength as needed.

6. What is the anticipated recovery after liposuction?

Most patients are able to return to work or academic programs within a week of liposuction. It is important to wear the compression garment as directed, most commonly for one month following surgery. If submental liposuction is performed (under the chin), Dr. Power recommends the neck compression garment be worn full-time for 1-2 weeks following surgery. It may then be worn outside of work hours for an additional 2 weeks as tolerated.

It is important to refrain from exercise, heavy lifting, or strenuous activities for one month following liposuction. This reduces the risk of bleeding, blood or fluid accumulation within the tissues (hematoma or seroma, respectively), and swelling.

7. What are potential complications of liposuction?

A comprehensive list of potential liposuction complications will be discussed in consultation. The majority of complications are minor, most commonly infection, fluid accumulation (seroma), or contour irregularities. The most common major complication following liposuction is venous thromboembolism – deep venous thromboembolism (DVT) or pulmonary embolism (PE).

Precautions are taken during surgery to reduce the risk of blood clot formation, including compression stockings on the lower legs and sequential compression devices. These devices decrease venous pooling in the lower legs during surgery. If additional risk factors are identified which place a patient at increased risk of developing venous thromboembolism, surgery may not be recommended. It is also important for patients to begin mobilizing early after surgery. Walking short distances after liposuction also increases blood flow and decreases risk of complications.

8. How much discomfort is to be expected following liposuction?

Most patients do not report significant discomfort following liposuction. It is a superficial procedure involving removal of fatty tissue through limited skin incisions. The tumescent fluid that is injected at the beginning of the case provides analgesia over the first few hours post-operatively. Patients may require prescription pain medication for a couple of days following surgery. They are generally able to wean quickly to Tylenol plain or extra-strength and then to completely discontinue all analgesia within a few days. Cold compresses are also beneficial for 48 hours post-operatively to reduce discomfort and swelling.

9. Are antibiotics required following liposuction?

Antibiotics are not routinely required post-operatively as prophylaxis to lower risk of infection. Risk of infection is quite low following liposuction in patients who are otherwise healthy and non-smokers.

10. How long does swelling last after liposuction?

The majority of swelling resolves over the first 2-3 months following liposuction. It may take up to one year for final results to become apparent as more minor swelling resolves and scar tissue matures. Wearing a compression garment is often helpful over the first month following liposuction to reduce excess swelling and to provide gentle compression as the skin begins to retract. Positioning during early recovery may also help to reduce swelling at specific sites. Following submental (under the chin) liposuction, for example, it is recommended to sleep with your head elevated on 2-3 pillows over the first month as tolerated. For liposuction of the lower extremities (knees, for example), elevation may also be beneficial over the first few weeks when able. Compression garments are particularly important following lower extremity liposuction, as well as avoiding prolonged standing and ambulation during early healing. These positioning maneuvers may reduce swelling following liposuction.

11. When may I resume exercise after liposuction?

It is recommended to refrain from exercise for one month post-operatively. This will lower the risk of bleeding, excess bruising, and swelling. Patients often ask if it is possible to continue exercise if the workout is modified to avoid targeting the specific body region. For example, would it be possible to avoid core exercises following abdominal liposuction and to continue running on the treadmill? Unfortunately not. Any type of exercise that increases heart rate and blood pressure may increase the risk of bleeding and increased swelling during early healing. Since surgery is being performed electively for aesthetic concerns, it is always recommended to closely follow post-operative activity modifications to optimize aesthetic results and to lower the risk of surgical complications.

12. How many areas may I have treated with liposuction during one procedure?

This answer will depend on the specific body regions, anticipated volume of aspirate, and length of general anesthetic. Limiting the volume of aspirate to less than 5L is associated with lower risk of complications. Generally 2-3 areas may be treated in one procedure. Dr. Power will discuss this in detail during your consultation based on your aesthetic concerns and clinical presentation.

13. How much weight will I lose after liposuction on average?

As previously mentioned, liposuction is not an effective technique for weight reduction. The amount of fat actually removed is quite minimal, generally less than 1-2 lbs. It is an effective technique for adding definition and removing persistent fatty deposits that are unresponsive to lifestyle modifications.

14. When may I return to work after liposuction?

Many patients are able to return to office-based work within a few days of liposuction. Jobs with more strenuous responsibilities may require a period of modified duties up to one month post-operatively if heavy lifting is required.

15. May liposuction be combined with other surgeries?

Yes. Liposuction is commonly performed of the flanks during tummy tuck surgery, as well as the lateral thoracic region (under the arms) during breast lift or reduction. Submental (under the chin) liposuction is another common site during neck lift. There may be increased risk of complications when liposuction is combined with other surgeries, which will be discussed during consultation. It is imperative to ensure that surgery is planned and executed safely given that combined liposuction may affect the blood supply at certain sites, lengthen the time under general anesthetic, as well as potentially increase risk of thromboembolism.

Liposuction is an effective tool for body contouring if performed in appropriately selected patients. Please contact us to schedule your consultation and to learn if liposuction is right for you.